<?php /* Smarty version 2.6.2, created on 2015-01-22 04:43:28
         compiled from C:%5Cwamp%5Cwww%5Cbolivar%5Cinterface%5Cforms%5Csoap/templates/general_new.html */ ?>
<html>
<head>
<?php html_header_show(); ?>

</head>
<body style="padding: 0; background: none repeat scroll 0px 0px rgb(249, 249, 249);">
<div class="borde_normal" style="padding: 0px;"><p><span class="historial_paciente"><i class="icon-file-text-alt" style="font-size: 1.2em;"></i> <?php  echo 'Consulta';  ?></span></p></div>
<form name="soap" method="post" action="<?php echo $this->_tpl_vars['FORM_ACTION']; ?>
/interface/forms/soap/save.php"
 onsubmit="return top.restoreSession()">
<table>
	<tr>
		<td align="left" style="padding-right: 20px;text-align: right; width: 145px;width: 25%;"><?php  echo 'Motivo de la consulta:';  ?></td>
		<td width="90%">
			<textarea name="motivo" cols="60" rows="4"><?php echo $this->_tpl_vars['data']->get_motivo(); ?>
</textarea>
		</td>
	</tr>
	<tr>
		<td align="left" style="padding-right: 20px;text-align: right; width: 145px;width: 25%;"><?php  echo 'Concepto:';  ?></td>
		<td width="90%">
			<textarea name="concepto" cols="60" rows="4"><?php echo $this->_tpl_vars['data']->get_concepto(); ?>
</textarea>
		</td>
	</tr>
	<tr>
		<td align="left" style="padding-right: 20px;text-align: right; width: 145px;width: 25%;"><?php  echo 'Enfermedad Actual:';  ?></td>
		<td width="90%">
			<textarea name="subjective" cols="60" rows="4"><?php echo $this->_tpl_vars['data']->get_subjective(); ?>
</textarea>
		</td>
	</tr>
	<tr>
		<td align="left" style="padding-right: 20px;text-align: right; width: 145px;width: 25%;"><?php  echo'Examen F&iacutesico:';  ?></td>
		<td width="90%">
			<textarea name="objective" cols="60" rows="4"><?php echo $this->_tpl_vars['data']->get_objective(); ?>
</textarea>
		</td>
	</tr>
	<tr>
		<td align="left" style="padding-right: 20px;text-align: right; width: 145px;width: 25%;"><?php  echo 'Plan de manejo:';  ?></td>
		<td width="90%">
			<textarea name="assessment" cols="60" rows="4"><?php echo $this->_tpl_vars['data']->get_assessment(); ?>
</textarea>
		</td>
	</tr>
	<tr>
		<td></td>
    <td></td>
</tr>
<tr>
		<td></td>
    <td></td>
</tr>
	<tr>
		<td></td>
    <td><input type="submit" class="css_button" name="Submit" value=<?php  xl('Save Form','e','"','"');  ?></td>
	</tr>
</table>
<input type="hidden" name="id" value="<?php echo $this->_tpl_vars['data']->get_id(); ?>
" />
<input type="hidden" name="activity" value="<?php echo $this->_tpl_vars['data']->get_activity(); ?>
">
<input type="hidden" name="pid" value="<?php echo $this->_tpl_vars['data']->get_pid(); ?>
">
<input type="hidden" name="process" value="true">
</form>
</body>
</html>